A deadly virus jumps the species barrier and quietly spreads. Little is done at first. Denial, discrimination and discord undermine an effective response. The poor and marginalized are the most exposed to infection and death, and the least able to cope with the broader impacts of the disease. Resentment and frustration build. Emotions boil over. Protestors march.

When HIV emerged as a global pandemic, change took years. When the calls from activists and the coffins of the dead could no longer be ignored, consensus was achieved, and global commitments were made. Public health actions that once seemed impossible are now commonplace.

An unprecedented global health crisis requires an unprecedented approach. For COVID-19, the time frame for debate and change has been compressed from years to weeks.

As health systems mobilize, communities lock down and economies slide into recession, COVID-19 has reminded the world of uncomfortable truths. Women are beset by violence in their own homes. Girls outside of school are exposed to harmful practices, including early marriage. Regulations and policing measures ostensibly aimed at maintaining law and order are used to harass and harm minority groups, the poor and the vulnerable. People who labour within informal economies work without a net, denied workplace health and safety standards, and ineligible for unemployment and health care benefits.

Efforts to undo centuries of inequality have been slow and prone to setbacks. The shackles of poverty, racism and sexism have been too easy for the privileged to ignore. A ravenous hunger for economic growth has too frequently overcome calls for action on climate change, and for expanded access to health care and strengthened social safety nets.

Simmering frustrations are again boiling over. Powerful men sexually assaulting young women cannot be tolerated. #MeToo. The killing of unarmed black men by white police officers is not a reasonable use of force. Black Lives Matter. Inequality must be confronted. Protestors again fill the streets.